August 1- Happy Nurses' Day

When I left the cushy chair of journalism for the hurly-burly world of nursing, I know I have some adjusting to do.

But after 2 ½ years of school and hospital, I still cannot adjust to the uncaring ways this caring profession has for its newcomers. If there is a profession that is quick to condemn its young and slow to praise them, nursing is it.

I first heard of the phrase “nurses eat their young” from my lecturer in school, himself a former nurse. By then, I have already encountered this formidable species in my hospital stints.

Granted, most nurses do not prey on their young, but there are enough black sheep around to give the rest a bad name.

It is easy to spot them. They are the ones who run into a mental block when it comes to understanding what it means to be new on the job. This never fails to flummox me because weren’t they once, too, a beginner? Didn’t they once, too, fumble while setting up an IV line, giving an injection, or dressing a wound? Apparently not. They have conveniently forgotten their inglorious past.

Whatever it is, you are expected to be as fast and skilful as if you are already 30 years into the job, and not your first year, or month. And if you are not up to their arbitrary standards, you may be given a tongue-lashing, taken off the learning curve or banished indefinitely to the Siberia of nursing chores to clear bedpans and clean backsides.

Speaking of tongue-lashing, some nurses have made this their true speciality.
I know of one who is so good at it that she never fails to leave her victims close to, or in tears. She knows the exact words to fool them into thinking they are the most stupid people in the history of mankind.

Like the rest of her tribe, she believes that humiliating a person and hacking their self-esteem to pieces, preferably before a crowd, is the only way to make them learn.
I cannot see the merits of this method of instructing. I believe I speak for most when I say I learn better under humane, rather than harsh, conditions.

But there appear to be an unwritten rule in nursing that you do not need to be civil to the novices. Student nurses often remain a part of the wall furniture until a patient cries out for a bedpan or a urinal, and then they become visible again to the ward staff.

Some veteran nurses find it only possible to speak to their less experienced colleagues only in a scolding tone.
They are often quick to pounce on your mistakes, but when you do good, no word of praise passes their lips.

It has been a true test of my patience to work with this predatory group of nurses, more challenging than any nursing skills I have to pick up so far.

But even as I train my patience, I implore nursing leaders to make mentoring skills a must for their senior staff before they unleash them on the new ones. The truth is many nurses are not good teachers, but until the day schools and hospitals stop recruiting, teaching is an essential part of their job. This is because most learning for new nurses happens on the job, and not in the classroom.

Finally, I would like to appeal to my seniors to recall their own fumbling days as student nurses when they work with us rookies. If we make mistakes, give us a chance to learn from them. Even better, share tips on how to avoid such mistakes. Don’t just label us as failures just because we have done wrong once or twice. And if we have done well, hey, it won’t hurt to give us a pat or two on the shoulder.

Happy nurses’ day.

Work has been getting me down

It's been a while since I posted. The truth is, work has been getting me down.

Or to be more specific, one particular person at work, this senior staff nurse, has been getting me down. I have never been so picked on in my life. Never been made to feel so inadequate and stupid.


Just the day before, a patient's urinary catheter was blocked and the doctor needed a 50cc syringe to flush the tube. I opened the packet and took out the syringe with my hands. Immediately, she shrieked, "You should throw the tube into the sterile field!" I retorted, "But the doctor's hand is not sterile!" She insisted however, and I had to throw away a clean syringe.


Earlier in the shift, she barked at me for leaving a folder open. "Can you please close the folder? I am not your maid to have to do everything for you."


These are but just two of countless similar episodes. I may see her for only about half an hour a day during the changing of shift, but somehow, she would manage to get me down during that short time.

I am at my wit's end. I have tried to buffer myself with thoughts along the lines of, "Nobody can make me unhappy without my permission". I have turned to self-help books on how to be more assertive. Manuel Smith's no 1. assertive right is, I have the right to judge my own behaviour, thoughts and emotions, and to take responsibility for their initiation and consequences upon myself.
And so far, I think my behaviour has been above board.
I have not done anything that is not in keeping with a new nurse. I don't need to feel bad about myself.

I think I have been so bothered by this person because I have never met someone who has only bad things to say about me. My ego cannot take it? It is also emotionally exhausting.
Whatever it is, I will not allow her to make me feel bad about myself again. As Smith said, I have the right to judge my own behaviour. As long as I behave in an appropriate manner, I won't be bothered by her hot bluster.

each life as a flower?

There are these lines in Mary Oliver's poem "When Death Comes",
"I think of each life as a flower, as common
as a field daisy, and as singular,

and each name a comfortable music in the mouth,
tending, as all music does, toward silence,

and each body a lion of courage, and something
precious to the earth."

Why is it so difficult to think of the chronic sick in these ways?

You are wasting your time

"You learn nothing. You are wasting your time here." More than one nurse have told me this about working with the chronic sick. Without fail, these words plunge me into a dark mood and I start to plot of ways to get out of this learn-nothing place to which I have signed a bond for three years. The thought of wasting away (the remaining years of my 30s) in this place frightens me. And yet, a small part of me wants to resist those words. Can it really be that I will learn nothing here? What did they say about it's not the "what" or "where" that matters but the "how"?

The Land of No Hope

Nurse asks young pretty doctor: "Can X (an enteric-coated medicine) be pounded?"
Doctor replies: "Who cares?"

Indeed. Who cares in this country of the chronic sick?
Often, not the family member, nor the health worker, or even the patient himself.
If the patient lives, so be it. If he dies, that's okay too.

How does one find hope in this land of the forsaken?
Should one even bother?

Helping words from Virginia Satir

I AM ME

In all the world, there is no one else
exactly like me.
There are persons who have some parts
like me,
but no one adds up exactly like me.
Therefore, everything that comes out of
me is authentically mine because I alone
chose it.
I own everything about me – my body,
including everything it does;
my mind, including all its thoughts and
ideas;
my eyes, including the images of all they
behold;
my feelings, whatever they may be –
anger, joy, frustration, love, disappoint-
ment, excitement;
my mouth, and all the words that come
out of it, polite, sweet or rough, correct
or incorrect;
my voice, loud or soft;
and all my actions, whether they be to
others or to myself.

I own my fantasies, my dreams, my
hopes, my fears.
I own all my triumphs and successes, all
my failures and mistakes.
Because I own all of me, I can become
intimately acquainted with me.
By so doing I can love me and be
friendly with me in all my parts.

I can then make it possible for all of me
to work in my best interests.
I know there are aspects about myself
that puzzle me, and other aspects that I
do not know.
But as long as I am friendly and loving
to myself, I can courageously and
hopefully look for the solutions to the
puzzles and for ways to find out more
about me.
However I look and sound, whatever I
say and do, and whatever I think and
feel at a given moment in time is me.
This is authentic and represents where I
am at that moment in time.
When I review later how I looked and
sounded, what I said and did, and how I
thought and felt, some parts may turn
out to be unfitting.

I can discard that which is unfitting, and
keep that which proved fitting, and in-
vent something new for that which I discarded.
I can see, hear, feel, think, say, and do.
I have the tools to survive, to be close
to others, to be productive, and to make
sense and order out of the world of
people and things outside of me.
I own me,
and therefore I can engineer me.
I am me
and I am okay.

Daily prayer

During work:
May I catch moments when I am opening up and shutting down, and put them down on a scrap of paper for reflection later?

After work:
May I remember to tranform these good and bad moments into:
Words (metaphors, poems)
Wit
Visuals

May I remember to "tonglen" them.
In other words, have the thought that my pain is shared and wishing that this pain can be a path of awakening for us, or in the case of joy, have the thought that I can share the joy with others.

Beamings from a sore thumb

A moment of mindlessness:
Slammed the door on my right thumb as I was getting out of a friend's car two days ago. Now nursing a swollen thumb and a magenta nail.

To feel better, I will myself to think of the merits of my plight, other than getting two days off work.

I think of those who, like me, have hurt themselves in accidents that could (or could they not?) have been avoided. All the "if onlys" that goes through their minds.
In my case, "if only I hadn't taken her car", or "if only I hadn't asked her to stop me at X", or "if only Y hadn't joined us, I would have sat in front, and this probably wouldn't have happened". If only. If only. If only. All the "if only" which does nothing to lessen the pain.

Even though it will take time, the damage to my thumb will probably un-do itself. I think of those (like my quadriplegic friend and some of my stroke patients), who have to live with the damage of their accidents. How horrible is that? What is my pain compared to theirs?

And why is it that we start to treasure things only after we have lost them? (Just like, why is it that I begin to miss my sister only after I have lost her?)
How I have taken my right thumb for granted. I can't hold a pen or peel a grape without it. I can't close a cap tight or wring a cloth dry. I can't work (make beds, do dressings, write reports) without it. Why, until the accident, I didnt know I do so many things with my right thumb, and for that matter, my right hand.

Can this be another reminder for me to pay gratitude to all parts of my body, and the people around me, before they are gone, as they surely will be one day?

Helping words from Stephen Levine's Who Dies

The Great Way is not difficult
for those who have no preferences.
When love and hate are both absent
everything becomes clear and undisguised.
Make the smallest distinction however,
and heaven and earth are set infinitely apart,
If you wish to see the truth
then hold no opinions for or against anything.
To set up what you like against what you dislike
is the disease of the mind.
When the deep meaning of things is not understood
the mind's essential peace is disturbed to no avail.
(from the third Zen patriarch)


The basic difference between an ordinary person and a warrior
is that the warrior takes
everything as a challenge whereas
an ordinary person takes everything as a blessing or a curse.
(from Don Juan)

Disappointments

Found: a bedsore.
Learnt: a doctor's instructions not followed.
Saw: milo not given to a patient.

My first race against time

My first race against time happened yesterday.
I had to serve medication for 30 patients -- without help.
No problem, I thought.
I started at 6pm. An hour later, I was supposed to go for my dinner break, but I had just about covered half the ward.
The senior nurse looked up over the nursing counter and remarked nonchalently: "Remember to time yourself. You don't want to be still serving medication when it's time to knock off."
Of course not, I thought, with a curl of my lips.
Don't be ridiculous, this would never happen here.
It didn't. I finished at around 8pm.
Phew.

Accomplishments

Made 30 beds in under 3 hours.
Inserted a Ryles tube -- my first successful attempt.
Changed the tapes securing the Ryles tube to patients' noses.
Took the blood pressure of a patient with contractured arm -- needed help.
Fed a Down's patient his blended diet.

Almost three weeks on

Slowing getting used to the rhythm of the morning shift.

The worst part of the shift is being rudely woken up, usually when I am in the middle of a dream, by the loud ringing of the alarm. And then dragging myself out of bed. My sleepiness usually takes about 10 minutes to disperse. Taking the bus and then walking to work is somehow depressing, maybe because of the dark. I try to counter my depression by praying, praying that I will remember to be mindful of my thoughts, feelings and body throughout this day, and praying that I will be able to somehow translate these into creative images, words and wit. Praying.

I start my shift with bedmaking, while the juniors trolley bathed the patients. Bedmaking is endurable if I take it as a purely physical activity. If I remember to concentrate on my body movements, to concentrate on my body movements. And then it's dressing time, something I quite enjoy, maybe because I used to do it in the acute setting. When I finish, it's around 10am, and I walk over to the hospital nearby for an early lunch. It is a mini-highlight of my shift. A time I enjoy. I try to remind myself to eat slowly, since there is plenty of time. Somehow, I cannot manage to stretch it more than five minutes. 10 minutes is an achievement. Something I can work on.

Then it's back to the ward -- time for sitting around, chitchatting with the other nurses, and writing or rather copying the previous reports. After which it's the next medication round. And then it's time for my second break. I usually try to have a fruit, and not a snack. I have been eating too much. Again, I must remind myself to eat slowly, to stretch my eating time, to taste my food, to have a conversation with my food. When I get out, it's almost time to pass over. I feel anticipation in the air. My mood lifts. When 2.30 finally strikes, I get out as fast as I can.

The best part of my day has began. I usually take a cup of milk tea and just chill -- write, doddle, read.

Yes, I think I can live with the morning shift. It's the afternoon shift that gets to me.

What do I do with all those free time?